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SAN .JOAQUIN COUN" <br /> a <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.or /q ehd <br /> �1FOR <br /> FO�O.,,D,, 1PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L/� Date: Z I <br /> Address: /(YIR City: Zip Code: <br /> Owner/Operator: /aC R4 - Telephone:Gr s 1—Gl 51 <br /> Program Element: �rLProgram Record: Inspection Type.- <br /> SB180 Posted es No' Permit Posted s No Re-Inspection on or After: <br /> OBSERVATEONS AI+ID CORRECTIVE 5 r w <br /> rrC <br /> t/►'L <br /> - 4/Lt vt <br /> v✓� <br /> R ,. Yx � ei>�►perature Item l LocationMET <br /> em�ierature <br /> Ad <br /> ttA Wg&W I <br /> — a <br /> I"ot3d"$ate G40#ic. tol ciltty NoI Water.temperature 1Natewash�ng , <br /> Name: /)/�� Hand Sink: / of Chlorine: ppm Heat: of <br /> Exp.Date: PIA arewashing Sink:! 'I� of Quat. mm.: ppm Other: of <br /> Received By/Title <br /> EH Specialist: Phone: <br /> ime in: Time Out: L` Page sof <br /> EHD 16-24 (2^ pg) 4/3+13 FOOD PROGRAM OIR CONTINUATION <br />